Measles cases more than tripled in Europe last year, with outbreaks and epidemics fueled by low vaccination rates, the World Health Organization says.

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“Every new person affected by measles in Europe reminds us that unvaccinated children and adults, regardless of where they live, remain at risk of catching the disease and spreading it to others who may not be able to get vaccinated,” Dr. Zsuzsanna Jakab, WHO Regional Director for Europe, said in a statement.

“Over 20,000 cases of measles, and 35 lives lost in 2017 alone, are a tragedy we simply cannot accept.”

Europe has been struggling to control measles for years. One of the worst recent years was 2013, when there were more than 10,000 cases across Europe. But 2017 had more than doubled that number.

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“The majority of people who got measles were unvaccinated,” the CDC says. “Travelers with measles continue to bring the disease into the U.S. Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.”

That’s what is happening in Europe, as well. The CDC has issued travel advisories about Europe, reminding Americans to make sure they are up to date on the measles, mumps and rubella (MMR) vaccine.

Experts say that to control measles, 95 percent of the population must be vaccinated or immune because of a past infection. Measles is one of the most infectious viruses — it infects 90 percent of people who are exposed to it if they aren’t immune, and it can hang in the air and infect people who enter a room as long as two hours after an infected person has left.

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WHO said Romania had the most cases last year with 5,562. Italy had more than 5,000 cases and Ukraine had 4,767 cases.

It says more than 20 million people were infected with measles in 2016.

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